Understanding general practitioner and pharmacist preferences for pharmacogenetic testing in primary care: a discrete choice experiment

Pharmacogenetic testing in the United Kingdom’s National Health Service (NHS) has historically been reactive in nature, undertaken in the context of single gene-drug relationships in specialist settings. Using a discrete choice experiment we aimed to identify healthcare professional preferences for development of a pharmacogenetic testing service in primary care in the NHS. Respondents, representing two professions groups (general practitioners or pharmacists), completed one of two survey versions, asking them to select their preferred pharmacogenetic testing service in the context of a presentation of low mood or joint pain. Responses from 235 individuals were included. All respondents preferred pharmacogenetic testing over no testing, though preference heterogeneity was identified. Both professional groups, but especially GPs, were highly sensitive to service design, with uptake varying depending on the service offered. This study demonstrates uptake of a pharmacogenetic testing service is impacted by service design and highlights key areas which should be prioritised within future initiatives.


Taking part in this research
Which of these options best describes your professional role?Please only complete this survey if you are a registered healthcare professional.Thank you for agreeing to take part in this study We will now show you a video which will provide some background information about pharmacogenetic testing.
After you have looked at this information we will ask you some questions about your preferences for pharmacogenetic testing in primary care.

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Background Information
Please watch this brief video that explains Pharmacogenetic Testing and its relevance in primary care.The video includes background information and instructions on how to complete the survey.
Back Next sciani 00:00 / 00:00 0% 100% Your preferences for a pharmacogenetic test in primary care We will now ask you to complete eight questions about your preferences for a pharmacogenetic test in primary care.In each question you will be shown two potential pharmacogenetic tests which vary in different ways.You will be asked to select which pharmacogenetic test you would prefer to offer to a patient.You can also choose not to offer a pharmacogenetic test.
Each test has five characteristics: 1 The Ability of the Test to Improve the Effectiveness of Treatment One aim of pharmacogenetic guided prescribing is that any results can be used to improve the effectiveness of a given treatment strategy by allowing you to modify the dose or choose alternative medicines.In the hypothetical examples given, the baseline chance of a medicine being effective is 50%.Different types of pharmacogenetic test can increase the effectiveness of a treatment strategy by different amounts.In the scenarios shown to you, there are four levels of effectiveness for you to consider:

50% (Baseline)
The pharmacogenetic test does not increase the chance of the subsequent treatment being effective compared to baseline -this means the chance of effectiveness remains at 50%

60%
The pharmacogenetic test increases the chance of the treatment strategy being effective from 50% (baseline) to 60%

70%
The pharmacogenetic test increases the chance of the treatment strategy being effective from 50% (baseline) to 70%

80%
The pharmacogenetic test increases the chance of the treatment strategy being effective from 50% (baseline) to 80%

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Effectiveness 0% 100% The Ability of the Test to Reduce the Risk of Adverse Drug Reactions One aim of pharmacogenetic guided prescribing is that any results can be used to improve the safety of a given medicine.
In the examples given, without a pharmacogenetic test, the chance of an adverse drug reaction occurring is 20%.Different types of pharmacogenetic test can decrease the risk of an adverse drug reaction by different amounts.In the scenarios shown to you, there are four levels of adverse drug reaction risk for you to consider:

20% (Baseline)
The pharmacogenetic test does not reduce the risk of an adverse drug reaction compared to baseline -this means the chance of an adverse drug reaction remains at 20%.

15%
The pharmacogenetic test decreases the risk of an adverse drug reaction from 20% (baseline) to 15%.

10%
The pharmacogenetic test decreases the risk of an adverse drug reaction from 20% (baseline) to 10%.

5%
The pharmacogenetic test decreases the risk of an adverse drug reaction from 20% (baseline) to 5%.

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ADRs 0% 100% How Test Results are Shared With the Clinical Team?
After a sample has been taken, it will be tested in the laboratory and results are made available to healthcare providers.There are four potential approaches for these results to be returned with clinicians:

Post
In this scenario, you will receive a letter in the mail with your patient's pharmacogenetic test results.

Email
In this scenario, you will receive your patient's pharmacogenetic test results via a secure email.

Web-Portal
In this scenario, you will be able to view your patient's pharmacogenetic test results via a dedicated website with your own secure login.

Within Electronic Health Record
In this scenario, results will be available within your electronic healthcare record system (i.e.EMIS/SystmOne/EPIC)

Time to Result (Turnaround Time)
Once a clinical sample has been taken, it has to be sent to a genetic laboratory for testing.Once the results are returned, you can then use this information to issue a prescription.The time it takes from a patient providing a sample to results being returned is known as the turnaround time or "time to result".In the hypothetical pharmacogenetic tests, there are four possible times to result:

Five (5) Days
In this scenario, you will receive the pharmacogenetic results five days after first seeing the patient in clinic.

Ten (10) Days
In this scenario, you will receive the pharmacogenetic results Ten days after first seeing the patient in clinic.

Fifteen (15) Days
In this scenario, you will receive the pharmacogenetic results fifteen days after first seeing the patient in clinic.

Twenty (20) Days
In this scenario, you will receive the pharmacogenetic results twenty days after first seeing the patient in clinic.

The type of genetic data returned to the clinical teams
There are many different types of pharmacogenetic test and many ways in which the data can be reported.This characteristic relates to the wider usefulness of the pharmacogenetic results once they have been returned.In the hypothetical pharmacogenetic tests, there are three approaches to returning results:

Focussed
In this scenario, pharmacogenetic results are only provided in relation to a single medicinei.e. the medicine for which the pharmacogenetic test was initially requested.The results cannot be used to help inform any additional future prescribing activity.

Narrow
The pharmacogenetic results will be returned in a format so they can be used to inform future prescribing activity.Prescribing guidance will only be returned where very strong evidence exists for a gene-drug pair.This will provide results for changes across five genes which can be used to inform the prescription of approximately twenty medicines.

Broad
The pharmacogenetic results will be returned in a format so they can be used to inform future prescribing activity.Prescribing guidance will be returned for all gene-drug pairs where there is any evidence, irrespective of strength.This will provide results for changes across fifty genes which can be used to inform the prescription of approximately two hundred medicines

Completing the Survey
Now that you have seen the potential characteristics of the pharmacogenetic tests, we will show you an example of a choice question.
Below is an example where the respondent has been asked to choose between two different pharmacogenetic tests (Test A and Test B), and the option to have no pharmacogenetic test.
They have chosen that they would prefer the second pharmacogenetic test (Test B) and not the first test (Test A) or for there to be no test.They have made this choice by clicking the "select" button at the bottom of each option.
We will now ask you to complete eight questions.Depending on the screen you are using to complete this survey, you may need to scroll down to view all the attributes within each test and access the "select" button.

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Imagine A Patient Presents to You With Low Mood
When considering your answers, imagine a patient presents to you with low mood which they have had for several months.As well as referring the patient for psychological support, you consider a trial of an antidepressant.
To help guide your treatment plan there is a new genetic test which can be used to help identify the most suitable medicine for your patient; increasing the chance that the medicine will work and lowering the risk side effects.This is known as a pharmacogenetic test.I think that genetics could be used to improve patient outcomes across all areas of healthcare I think that genetics has the potential to improve patient outcomes, but only in certain areas of healthcare I think that genetics is useful to investigate rare disease and cancer, but is not that useful in other areas of medicine I think that genetics isn't useful in healthcare We would now like to ask you some questions about yourself

Remuneration -Prize Draw
Many thanks for taking part in this research.For taking part, you are eligible to enter a prize draw to win a £25 gift voucher.There are 40 vouchers to be won in total and winners will be notified by email once the study has closed.
To enter the prize draw you will need to provide your email.This will be stored on a secure server at the University of Manchester and will not be used for any purposes other than for the draw.Once the draw is complete, all emails will be permanently deleted.
If you wish to enter the prize draw, please enter your email.Otherwise, leave blank.Please note, this should be a professional email address which will be used for validation.

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The ability of the test to improve the effectiveness of a medicine 2. The ability of the test to reduce the risk of adverse drug reactions 3. How you receive the test results 4. The time taken from having the test to receiving the results (turn around time) 5.The type of genetic data returned to the clinical teams These characteristics and the potential levels they can take are explained over the next five You will be asked to choose from two different testing options (Test A or Test B) to offer your patient.You also have the option to not offer the test (you had to choose one of these pharmacogenetic (PGx) tests (Test A or Test B) to help guide your treatment, which would you choose?When considering your answers, you should imagine a patient has presented to you with low mood and you are ordering a pharmacogenetic test to help guide antidepressant therapy.you had to choose one of these pharmacogenetic (PGx) tests (Test A or Test B) to help guide your treatment, which would you choose?When considering your answers, you should imagine a patient has presented to you with low mood and you are ordering a pharmacogenetic test to help guide antidepressant therapy.you had to choose one of these pharmacogenetic (PGx) tests (Test A or Test B) to help guide your treatment, which would you choose?When considering your answers, you should imagine a patient has presented to you with low mood and you are ordering a pharmacogenetic test to help guide antidepressant therapy.you had to choose one of these pharmacogenetic (PGx) tests (Test A or Test B) to help guide your treatment, which would you choose?When considering your answers, you should imagine a patient has presented to you with low mood and you are ordering a pharmacogenetic test to help guide antidepressant therapy.you had to choose one of these pharmacogenetic (PGx) tests (Test A or Test B) to help guide your treatment, which would you choose?When considering your answers, you should imagine a patient has presented to you with low mood and you are ordering a pharmacogenetic test to help guide antidepressant therapy.you had to choose one of these pharmacogenetic (PGx) tests (Test A or Test B) to help guide your treatment, which would you choose?When considering your answers, you should imagine a patient has presented to you with low mood and you are ordering a pharmacogenetic test to help guide antidepressant therapy.you had to choose one of these pharmacogenetic (PGx) tests (Test A or Test B) to help guide your treatment, which would you choose?When considering your answers, you should imagine a patient has presented to you with low mood and you are ordering a pharmacogenetic test to help guide antidepressant therapy.like to ask you some questions about how you found answering these questions Q9: How confident are you that you would make the same choices if faced with the situations in real-life?Very confident I would make the same choices Quite confident I would make the same choices Not confident I would make the same choices Q10: On a scale of 1 to 5, how easy or difficult did you find making choices between the alternatives?you find yourself making choices based on the same attribute each time?(i.e. did you think one attribute was more important to you than others) Yes, I focussed on one of the attributes more than others No, I used all of the attributes to make my indicate which of the following statements best reflects your views of using genetics in healthcare.

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